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Who has a repeat abortion? Identifying women at risk of repeated terminations of pregnancy: analysis of routinely collected health care data
  1. Stephen J McCall1,2,
  2. Gillian Flett3,
  3. Emmanuel Okpo4,
  4. Sohinee Bhattacharya5
  1. 1Research Assistant, Epidemiology Group, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
  2. 2DPhil Student, National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
  3. 3Consultant in Sexual and Reproductive Health, Department of Sexual Health, NHS Grampian, Aberdeen, UK
  4. 4Consultant in Public Health Medicine, Department of Public Health, NHS Grampian, Aberdeen, UK
  5. 5Senior Lecturer, in Obstetric Epidemiology Epidemiology Group, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, University of Aberdeen, Aberdeen, UK
  1. Correspondence to Dr Sohinee Bhattacharya, Epidemiology Group, Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital, University of Aberdeen AB25 2ZL, UK; sohinee.bhattacharya{at}abdn.ac.uk

Abstract

Background Repeat termination of pregnancy highlights the issues of unplanned pregnancies and effective post-termination contraceptive practices.

Objective To examine the risk factors at the time of a first termination that are associated with subsequent repeat termination.

Design Registry-based study.

Setting Grampian region of Scotland, UK.

Methods A retrospective study using data from the Termination of Pregnancy Database, NHS Grampian for the period 1997–2013. Associations between repeat termination and women's sociodemographic characteristics and contraceptive use were assessed using multivariable logistic regression models.

Results This study showed that 23.4% of women who had an initial termination (n=13 621) underwent a repeat termination. Women who had repeat terminations were more likely to be aged under 20 years at their initial termination with an adjusted odds ratio (AOR) of 5.59 [95% confidence interval (CI) 4.17–7.49], to belong to the most deprived social quintile [AOR 1.23 (95% CI 1.05–1.43)], and to be more likely to have had two or more previous livebirths [AOR 1.51 (95% CI 1.12–2.02)] or miscarriages [AOR 1.40 (95% CI 1.02–1.92)]. The likelihood of having a repeat termination was increased in women who had a contraceptive implant as post-termination contraception [AOR 1.78 (95% CI 1.50–2.11)] compared to women who left with none or unknown methods following the first termination. In those who had repeat terminations, women who had an implant or Depo-Provera® were at increased odds of repeat termination in the 2–5 years interval compared to the 0–2 years after their initial termination.

Conclusions Teenage pregnancy, social deprivation, two or more previous livebirths or miscarriages at the time of the initial termination were identified as risk factors for repeat terminations. Post-termination contraception with implants and Depo-Provera® were associated with repeat termination 2–5 years after the first termination.

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